US Health Care Signups Hit 2.2M, Mostly Ages 55-64

Enrollments under the federal Affordable Health Care Act have reached 2.2 million, still trailing the target number sought by the Obama administration and also showing a need for more younger applicants.

Laptop displays the HealthCare.gov website (Joe Raedle/Getty Images)

Insurers, nonprofit groups and advocates are adding momentum with marketing campaigns that were put on hold when the federal website that serves 36 states was struggling during its rollout.

Some of the highlights:

The administration continues to play catch-up. Originally, officials hoped to sign up more than 3.3 million people through the end of 2013, nearly halfway to the goal of 7 million enrollments by the end of March. Instead, enrollment as of Dec. 31 was not quite 2.2 million.

Fifty-four percent of those who signed up were women, a slightly higher proportion of females than in the population.

Nearly four out of five who signed up got financial help with their premiums.

The most popular coverage option was a so-called silver plan, which covers about 70 percent of expected medical costs. Three out of five people picked silver. One in five picked a lower-cost bronze plan. Only 13 percent picked gold, which most closely compares to the typical employer plan. Another 7 percent went for top-tier platinum plans, and about 1 percent picked skimpy “catastrophic” plans available only to certain groups of people, including those under 30.

A few states accounted for a huge share of the enrollment. California alone had 23 percent of the signups. California, New York, Florida, Texas and North Carolina accounted for nearly half the total.

Some questions remained unanswered. For example, the administration is unable to say how of many of those enrolling for coverage had been previously uninsured. Some might have been among the more than 4.7 million insured people whose previous policies were canceled because they didn’t meet the law’s standards.

In Miami, 19-year-old college student Stacy Sylvain was one of the last-minute online signups as 2013 drew to a close. In about an hour, the part-time waitress signed up for a plan with a $158 monthly premium, with the feds kicking in $48. She has a $2,500 deductible. Sylvain said she had no trouble navigating the website.

“Many people have a preconceived notion that young people are healthy and don’t need to go to the doctor,” said Sylvain, who suffered a minor injury when she fell and hit her head during an indoor soccer class in 2012. “Not having to worry about being uninsured and the what-ifs has made an incredible impact on my life.”

Considering that the federal health care website was down most of the time in October, administration officials said they were pleased that the percentage of young adults was as high as it was.

Enrolling young and healthy people is important because they generally pay more into the system than they take out, subsidizing older adults. Many experts expected older, sicker people to be more heavily represented in the early numbers. Younger people might procrastinate, waiting until the March 31 enrollment deadline is near, weighing whether they want to risk tax penalties for remaining uninsured.

“The dynamic of younger people is that they are going to get educated, they are going to get informed, and they are going to enroll as we get closer to that deadline,” said Aaron Smith, founder of Young Invincibles, an advocacy group for young adults.

But even if the age mix remains tilted toward older adults, “it’s nothing of the sort that would trigger instability in the system,” said Larry Levitt, an insurance expert with the nonpartisan Kaiser Family Foundation. Premiums would go up next year for the overhaul, along with taxpayer costs per enrollee, but not enough to push the system into a “death spiral” in which rising premiums discourage healthy people from signing up.

Still, he said, “it underscores a need to heighten outreach efforts to young people.”

Administration officials said that in the coming weeks they plan to increase outreach to young people in 25 communities located in states served by the federal website. That effort includes a national youth enrollment day on Feb. 15 and targeted outreach by sororities and fraternities, as well as Voto Latino, which focuses on Hispanic youth.

“We think that more and more young people are going to sign up as time goes by,” said Gary Cohen, head of the Health and Human Services Department’s office in charge of Obama’s push to cover the uninsured.

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